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Sharp TH, Chideya Y, Giuliani A, Hunt X, Tomlinson M, Seedat S, Creswell C, Fearon P, Hamilton-Giachritsis C, Hiller R, Meiser-Stedman R, Du Toit S, Stewart J, Halligan SL. Post-traumatic stress disorder symptoms following exposure to acute psychological trauma in children aged 8-16 years in South Africa: protocol for the Sinethemba longitudinal study. BMJ Open 2024; 14:e085129. [PMID: 38991675 DOI: 10.1136/bmjopen-2024-085129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Children exposed to trauma are vulnerable to developing post-traumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and middle-income countries (LMICs), children are at increased risk of exposure to severe trauma and co-occurring adversities. However, relative to high-income countries, there is limited evidence of the factors that predict good versus poor psychological recovery following trauma exposure in LMIC children, and the role of caregiver support in these high-adversity communities. METHODS AND ANALYSIS We will conduct a longitudinal, observational study of 250 children aged 8-16 years and their caregivers in South Africa, following child exposure to acute trauma. Dyads will be recruited from community hospitals following a potentially traumatic event, such as a motor vehicle accident or assault. Potential participants will be identified during their hospital visit, and if they agree, will subsequently be contacted by study researchers. Assessments will take place within 4 weeks of the traumatic event, with 3-month and 6-month follow-up assessments. Participants will provide a narrative description of the traumatic event and complete questionnaires designed to give information about social and psychological risk factors. Child PTSD symptoms will be the primary outcome, and wider trauma-related mental health (depression, anxiety, behavioural problems) will be secondary outcomes. Regression-based methods will be used to examine the association of psychosocial factors in the acute phase following trauma, including caregiver support and responding, with child PTSD and wider mental health outcomes. ETHICS AND DISSEMINATION Ethical approvals have been granted by Stellenbosch University and the University of Bath, with additional approvals to recruit via hospitals and healthcare clinics being granted by the University of Cape Town, the Department of Health and the City of Cape Town. Study findings will be disseminated via publication in journals, workshops for practitioners and policy-makers, and public engagement events.
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Affiliation(s)
| | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Pasco Fearon
- University of Cambridge Centre for Family Research, Cambridge, UK
| | | | - Rachel Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia Norwich Medical School, Norwich, UK
| | - Stefani Du Toit
- Department of Psychiatry, University of Cape Town, Rondebosch, South Africa
| | - Jackie Stewart
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Surgery, University of Cape Town, Rondebosch, South Africa
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Berring LL, Holm T, Hansen JP, Delcomyn CL, Søndergaard R, Hvidhjelm J. Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare (Basel) 2024; 12:908. [PMID: 38727465 PMCID: PMC11083630 DOI: 10.3390/healthcare12090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark;
| | - Jens Peter Hansen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Retspsykiatrisk Forskningsenhed, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Christian Lie Delcomyn
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department for Forensic Psychiatry, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark
| | - Rikke Søndergaard
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
| | - Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center Sct Hans, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark;
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Connell CM, Swanson AS, Genovese M, Lang JM. Effects of child trauma screening on trauma-informed multidisciplinary evaluation and service planning in the child welfare system. J Trauma Stress 2024; 37:337-343. [PMID: 38193592 DOI: 10.1002/jts.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
Despite the prevalence of exposure to potentially traumatic events (PTEs) among children involved with the child welfare system (CWS), trauma screening is not yet a common practice. The purpose of this study was to assess the impact of embedding a formal trauma screening process in statewide multidisciplinary evaluations for CWS-involved youth. A retrospective record review was conducted with two random samples of cases reflecting both pre- and postimplementation of formal screening procedures (n = 70 preimplementation, n = 100 postimplementation). Findings from the record review indicate statistically significant improvements in the documentation of general, χ2(1, N = 170) = 18.8, p < .001, and specific, χ2(1, N = 170) = 10.7, p = .001, details of children's reactions associated with PTE exposure, as well as increases in providers' recommendations, χ2(1, N = 170) = 18.1, p < .001, and referrals, χ2(1, N = 170) = 4.5, p = .034, for trauma-focused services. The early identification of trauma-related symptoms may help connect children more promptly to trauma-informed evidence-based interventions, which may avert or mitigate the long-term sequelae of child maltreatment and CWS involvement.
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Affiliation(s)
- Christian M Connell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
- Child Maltreatment Solutions Network, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ann Shun Swanson
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Maegan Genovese
- The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason M Lang
- Child Health and Development Institute, Farmington, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, UConn Health, Farmington, Connecticut, USA
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Chaplo SD, Shepard Abdulahad LD, Keeshin BR. Utilizing screening as a trauma-responsive approach in pediatric health care settings. Curr Probl Pediatr Adolesc Health Care 2024; 54:101548. [PMID: 38336539 DOI: 10.1016/j.cppeds.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Given the widespread impact of child trauma, it is important that child- and family-serving systems adopt trauma-informed care. Because of their integral relationships with families, pediatricians and family medicine physicians play critical roles in disrupting negative societal and developmental cascades for trauma-exposed youth through their potential for early identification and intervention. When implemented alongside organization-wide trauma-informed care practices, trauma screening is one concrete trauma-informed care practice that has shown both feasibility and positive impacts on pediatric healthcare. In support of this practice, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) helps pediatric care providers to identify and respond to children and adolescents who may need trauma-focused supports. In this paper we discuss the importance of pediatric physicians adopting trauma-informed care and how evidence-based screening practices in pediatric settings is a trauma-responsive approach with great potential for meeting unmet needs among trauma-exposed children and families.
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Lang JM, Lange BCL, Connell CM, Duran T. The feasibility and utility of trauma screening for children involved in the juvenile justice system. J Trauma Stress 2023; 36:861-872. [PMID: 37399118 DOI: 10.1002/jts.22953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 07/05/2023]
Abstract
Childhood exposure to potentially traumatic events and adversity is highly prevalent and linked to adverse outcomes. Many children suffering from symptoms related to traumatic stress are not identified or do not receive appropriate trauma-focused treatment, including evidence-based treatments. Trauma screening is a promising strategy to improve identification, but many child-serving staff members have concerns about asking youth and caregivers about trauma. This study aimed to describe staff perceptions about the feasibility, utility, and potential for distress associated with trauma screening. Between 2014 and 2019, the Child Trauma Screen was used in 1,272 trauma screenings completed by juvenile probation officers or mental health clinicians as part of routine practice with youth in the juvenile justice system. Further, 1,190 caregiver reports about youth trauma were completed for youth in the juvenile justice system. Staff completed a brief postscreening survey about the feasibility and utility of the screening and the perceived level of child or caregiver distress. Across staff roles, trauma screening was deemed to be feasible and worthwhile to practice, with very few staff members reporting that children or caregivers appeared very uncomfortable as a result of screening, although some differences in feasibility and utility by staff role did occur. Trauma screening measures appear to be useful and practical in juvenile justice settings when appropriate support is provided, including when administered by nonclinical staff. Nonclinical staff may benefit from additional training, consultation, or support with trauma screening.
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Affiliation(s)
- Jason M Lang
- Child Health and Development Institute of Connecticut, Inc., Farmington, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, UConn Health, Farmington, Connecticut, USA
| | - Brittany C L Lange
- Child Health and Development Institute of Connecticut, Inc., Farmington, Connecticut, USA
| | - Christian M Connell
- Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
- Child Maltreatment Solutions Network, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Tracy Duran
- Court Support Services Division, Connecticut Judicial Branch, Rocky Hill, Connecticut, USA
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Schreier A, Stenersen MR, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. CHILDREN AND YOUTH SERVICES REVIEW 2023; 147:106838. [PMID: 37719138 PMCID: PMC10501261 DOI: 10.1016/j.childyouth.2023.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.
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Affiliation(s)
- Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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Ng LC, Oblath R, Brigham R, Tai MH, Coles M. Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care. Child Adolesc Psychiatry Ment Health 2022; 16:71. [PMID: 35999580 PMCID: PMC9397184 DOI: 10.1186/s13034-022-00501-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care. METHODS The APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C). RESULTS 56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms. CONCLUSIONS Many youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.
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Affiliation(s)
- Lauren C. Ng
- grid.19006.3e0000 0000 9632 6718Present Address: Department of Psychology, University of California Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563 USA ,Department of Psychiatry, Boston Medical Center, Boston University, Boston, MA USA
| | - Rachel Oblath
- grid.239424.a0000 0001 2183 6745Department of Psychiatry, Boston Medical Center, Boston, MA United States
| | - Rebecca Brigham
- grid.239424.a0000 0001 2183 6745Department of Pediatrics, Boston Medical Center, Boston, MA USA
| | - Ming Him Tai
- grid.239424.a0000 0001 2183 6745Department of Psychiatry, Boston Medical Center, Boston, MA United States ,grid.17635.360000000419368657Present Address: University of Minnesota, Minneapolis, MN USA ,grid.189504.10000 0004 1936 7558Department of Psychology, Boston University, Boston, MA USA
| | - Mandy Coles
- grid.239424.a0000 0001 2183 6745Department of Pediatrics, Boston Medical Center, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston University, Boston, MA USA
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Sheerin KM, Modrowski CA, Williamson S, Kemp KA. The Effect of Sexual Concerns on Placement Changes and School Transfers for Youth in the Child Welfare System. CHILDREN AND YOUTH SERVICES REVIEW 2022; 138:106520. [PMID: 38223234 PMCID: PMC10785607 DOI: 10.1016/j.childyouth.2022.106520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Youths in the child welfare system experience high rates of placement changes and school transfers; therefore, prior research focused on variables that may be linked with such disruptions. Indeed, researchers have established that mental health symptoms (e.g., PTSD symptoms) are linked with placement disruptions. However, an important aspect of mental health for youth in the child welfare system has largely been ignored: sexual concerns (e.g., distress, preoccupation). Thus, the present study evaluated whether higher levels of sexual preoccupation and distress among a sample of child welfare-involved youths (N = 124) in a northeastern state predicted placement changes and school transfers above and beyond variables previously linked with these disruptions. Our hypotheses were partially supported such that higher levels of sexual distress were linked with increased odds of experiencing a placement change (OE = 2.60; p <.01). Counter to our hypotheses, higher levels of sexual preoccupation were linked with lower odds of experiencing both placement changes (OE = -2.98; p <.01) and school transfers (OR = 0.18; p < .05). Furthermore, sexual preoccupation and sexual distress were not linked with increased rates of placement changes. The current findings have implications for the assessment of sexual concerns and the prevention of placement changes among youth in the child welfare system.
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Affiliation(s)
| | - Crosby A. Modrowski
- Warren Alpert Medical School of Brown University
- Hasbro Children’s Research Center/Rhode Island Hospital
| | | | - Kathleen A. Kemp
- Warren Alpert Medical School of Brown University
- Hasbro Children’s Research Center/Rhode Island Hospital
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9
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Stenersen MR, Kelly A, Bracey J, Marshall T, Cummins M, Clark K, Kaufman JS. Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders. Psychiatr Serv 2022; 73:526-532. [PMID: 34470504 PMCID: PMC8888774 DOI: 10.1176/appi.ps.202100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. METHODS This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire. RESULTS Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care. CONCLUSIONS Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Aleece Kelly
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Jeana Bracey
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Tim Marshall
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Mary Cummins
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Kathryn Clark
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
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Hyland P, Karatzias T, Ford JD, Fox R, Spinazzola J. The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm : LATENT STRUCTURE OF PSYCHOPATHOLOGY. Res Child Adolesc Psychopathol 2022; 50:1501-1513. [PMID: 35476235 PMCID: PMC9616783 DOI: 10.1007/s10802-022-00925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Thanos Karatzias
- Department of Psychology, Edinburgh Napier University, Edinburgh, Scotland
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robert Fox
- School of Business, National College of Ireland, Dublin, Ireland
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Ford JD, Charak R, Karatzias T, Shevlin M, Spinazzola J. Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach. Eur J Psychotraumatol 2022; 13:2133488. [PMID: 36340008 PMCID: PMC9635476 DOI: 10.1080/20008066.2022.2133488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). OBJECTIVE To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. METHOD Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. RESULTS A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). CONCLUSION Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center MC1410, Farmington, CT, USA
| | - Ruby Charak
- University of Texas Rio Grande Valley, Edinburg, TX, USA
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12
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Goddard A, Janicek E, Etcher L. Trauma-informed care for the pediatric nurse. J Pediatr Nurs 2022; 62:1-9. [PMID: 34798581 PMCID: PMC9757999 DOI: 10.1016/j.pedn.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is not limited to medical trauma and includes chronic stressors, toxic stress, adverse childhood events, abuse, and now the COVID-19 pandemic. Principles of trauma-informed care and resiliency guide pediatric nursing care across the life span from birth to adolescence. Trauma-informed care principles are pertinent to the nursing care needs of healthy and ill children from infancy to adolescence across care settings. METHODS The purpose of this integrative literature review (IRL) is to elucidate evidence-based practices for pediatric nurses specific to trauma, trauma-informed principles, and the integration of these principles to care. Using Whittemore and Knafl's (2005) methodology, this IRL presents empirical literature to operationalize trauma-informed care for the pediatric nurse through 1) identification of the problem; 2) literature search; 3) data evaluation; 4) data analysis; 5) result presentation. FINDINGS Results are presented in a contemporary framework by the Substance Abuse and Mental Health Services Administration (2018) of trauma-awareness for the pediatric nurse, trauma-informed principles, and the integration of these principles to care. Pediatric nurses are in a unique position to offer trauma-informed care by recognizing and managing trauma to include chronic stressors, toxic stress, adverse childhood experiences, and abuse. DISCUSSION Pediatric nurses today are caring for patients in a complex and diverse healthcare climate amid the world's worst public health pandemic in living memory. Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.
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Affiliation(s)
- Anna Goddard
- Quality, Research, & Evaluation, School-Based Health Alliance, United States of America; Sacred Heart University, Davis & Henley College of Nursing, United States of America; Child and Family Agency of Southeastern Connecticut, United States of America.
| | - Erin Janicek
- Child and Family Agency of Southeastern Connecticut, United States of America.
| | - LuAnn Etcher
- Sacred Heart University, Davis & Henley College of Nursing, United States of America.
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13
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Wright N, Hill J, Sharp H, Pickles A. Interplay between long-term vulnerability and new risk: Young adolescent and maternal mental health immediately before and during the COVID-19 pandemic. JCPP ADVANCES 2021; 1:e12008. [PMID: 34485987 PMCID: PMC8206735 DOI: 10.1111/jcv2.12008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background We examine whether there has been an increase in young adolescent and maternal mental health problems from pre- to post-onset of the COVID-19 pandemic. Methods Children aged 11-12 years and their mothers participating in a UK population-based birth cohort (Wirral Child Health and Development Study) provided mental health data between December 2019 and March 2020, and again 3 months after lockdown, 89% (N = 202) of 226 assessed pre-COVID-19. Emotional and behavioural problems were assessed by self- and maternal reports, and long-term vulnerability by maternal report of prior child adjustment, and maternal prenatal depression. Results The young adolescents reported a 44% (95% confidence interval [CI: 23%-65%]) increase in symptoms of depression and 26% (95% CI [12%-40%]) for post-traumatic stress disorder, with corresponding maternal reports of child symptoms of 71% (95% CI [44%-99%]) and 43% (95% CI 29%-86%). Disruptive behaviour problem symptoms increased by 76% (95% CI [43%-109%]) particularly in children without previous externalising symptoms. Both female gender and having had high internalising symptoms earlier in childhood were associated with elevated rates of depression pre-pandemic, and with greater absolute increases during COVID-19. Mothers' own depression symptoms increased by 42% (95% CI [20%-65%]), and this change was greater among mothers who had prenatal depression. No change in anxiety was observed among children or mothers. None of these increases were moderated by COVID-19-related experiences such as frontline worker status of a parent. Prior to the pandemic, rates of maternal and child depression were greater in families experiencing higher deprivation, but changed only in less deprived families, raising their rates to those of the high deprivation group. Conclusions COVID-19 has led to a marked increase in mental health problems in young adolescents and their mothers with concomitant requirements for mental health services to have the resources to adapt to meet the level and nature of the needs.
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Affiliation(s)
- Nicola Wright
- Department of Biostatistics & Health Informatics Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences University of Reading Reading Berkshire UK
| | - Helen Sharp
- Department of Life and Human Sciences University of Liverpool Liverpool Merseyside UK
| | - Andrew Pickles
- Department of Biostatistics & Health Informatics Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
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14
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Schreier A, Horwitz M, Marshall T, Bracey J, Cummins M, Kaufman JS. Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2021; 29:175-186. [PMID: 34712039 PMCID: PMC8547490 DOI: 10.1177/1063426620980695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.
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Affiliation(s)
| | | | - Tim Marshall
- Connecticut Department of Children and Families, Hartford, USA
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Mary Cummins
- Connecticut Department of Children and Families, Hartford, USA
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15
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Peterson BS, West AE, Weisz JR, Mack WJ, Kipke MD, Findling RL, Mittman BS, Bansal R, Piantadosi S, Takata G, Koebnick C, Ashen C, Snowdy C, Poulsen M, Arora BK, Allem CM, Perez M, Marcy SN, Hudson BO, Chan SH, Weersing R. A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders. BMC Psychiatry 2021; 21:323. [PMID: 34193105 PMCID: PMC8243307 DOI: 10.1186/s12888-021-03314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Treatment of a child who has an anxiety disorder usually begins with the question of which treatment to start first, medication or psychotherapy. Both have strong empirical support, but few studies have compared their effectiveness head-to-head, and none has investigated what to do if the treatment tried first isn't working well-whether to optimize the treatment already begun or to add the other treatment. METHODS This is a single-blind Sequential Multiple Assignment Randomized Trial (SMART) of 24 weeks duration with two levels of randomization, one in each of two 12-week stages. In Stage 1, children will be randomized to fluoxetine or Coping Cat Cognitive Behavioral Therapy (CBT). In Stage 2, remitters will continue maintenance-level therapy with the single-modality treatment received in Stage 1. Non-remitters during the first 12 weeks of treatment will be randomized to either [1] optimization of their Stage 1 treatment, or [2] optimization of Stage 1 treatment and addition of the other intervention. After the 24-week trial, we will follow participants during open, naturalistic treatment to assess the durability of study treatment effects. Patients, 8-17 years of age who are diagnosed with an anxiety disorder, will be recruited and treated within 9 large clinical sites throughout greater Los Angeles. They will be predominantly underserved, ethnic minorities. The primary outcome measure will be the self-report score on the 41-item youth SCARED (Screen for Child Anxiety Related Disorders). An intent-to-treat analysis will compare youth randomized to fluoxetine first versus those randomized to CBT first ("Main Effect 1"). Then, among Stage 1 non-remitters, we will compare non-remitters randomized to optimization of their Stage 1 monotherapy versus non-remitters randomized to combination treatment ("Main Effect 2"). The interaction of these main effects will assess whether one of the 4 treatment sequences (CBT➔CBT; CBT➔med; med➔med; med➔CBT) in non-remitters is significantly better or worse than predicted from main effects alone. DISCUSSION Findings from this SMART study will identify treatment sequences that optimize outcomes in ethnically diverse pediatric patients from underserved low- and middle-income households who have anxiety disorders. TRIAL REGISTRATION This protocol, version 1.0, was registered in ClinicalTrials.gov on February 17, 2021 with Identifier: NCT04760275 .
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Affiliation(s)
- Bradley S. Peterson
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Psychiatry, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Amy E. West
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - John R. Weisz
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, USA
| | - Wendy J. Mack
- grid.42505.360000 0001 2156 6853Department of Preventive Medicine, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Michele D. Kipke
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA ,grid.42505.360000 0001 2156 6853Department of Preventive Medicine, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Robert L. Findling
- grid.224260.00000 0004 0458 8737Virginia Commonwealth University, Richmond, USA
| | - Brian S. Mittman
- grid.414895.50000 0004 0445 1191Department of Research & Evaluation, Kaiser Permanente, Los Angeles, USA
| | - Ravi Bansal
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Steven Piantadosi
- grid.38142.3c000000041936754XBrigham And Women’s Hospital, Harvard Medical School, Boston, USA
| | - Glenn Takata
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Corinna Koebnick
- grid.414895.50000 0004 0445 1191Department of Research & Evaluation, Kaiser Permanente, Los Angeles, USA
| | - Ceth Ashen
- Children’s Bureau of Southern California, Los Angeles, USA
| | - Christopher Snowdy
- grid.42505.360000 0001 2156 6853Department of Psychiatry, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Marie Poulsen
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Bhavana Kumar Arora
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Courtney M. Allem
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Marisa Perez
- Hathaway-Sycamores Child and Family Services, Altadena, USA
| | - Stephanie N. Marcy
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Bradley O. Hudson
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | | | - Robin Weersing
- grid.263081.e0000 0001 0790 1491SDSU-UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, USA
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16
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Grace E, Sotilleo S, Rogers R, Doe R, Olff M. Semantic adaptation of the Global Psychotrauma Screen for children and adolescents in the United States. Eur J Psychotraumatol 2021; 12:1911080. [PMID: 34104348 PMCID: PMC8168728 DOI: 10.1080/20008198.2021.1911080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The review of trauma screening tools for children and adolescents indicates a need for developmentally and linguistically appropriate, globally applicable, free, and easily accessible trauma screening instruments. Objective: The aim of this study is to adapt the Global Psychotrauma Screen (GPS) for children and adolescents in the United States. Method: Using the modified Delphi method, this study included the GPS Expert Consensus (GPS-EC) and the GPS Stakeholder Consensus (GPS-SC) substudies. In the GPS-EC, ten reviewers who specialize in trauma services independently revised the GPS child and adolescent versions in four rounds. In the GPS-SC, a stratified minimum sample of children and adolescents (n = 24) and their parents (n = 24) were interviewed to collect feedback on the revised GPS versions. Results: In the GPS-EC Round 1, a low level of consensus was observed on the anxiety (restlessness) and depression (loss of interest) items. In Round 2, a high level of consensus was achieved on all but PTSD hypervigilance and detachment, and CPTSD self-concept items. Round 3 indicated a low level of consensus on the exposure and functioning items. Full consensus was achieved in Round 4 on all items. In the GPS-SC, children had more difficulties than adolescents with the exposure, dissociation, and risk-protection items. Conclusions: Based on the results of this study, the semantic adaptation process concluded with implementation of six decisions on the final GPS versions for children and adolescents: adding a non-binary gender choice for adolescents; removing the exposure section; using a full-sentence structure for children and a phrase structure for adolescents; retaining the two-part items on PTSD intrusion and avoidance, retaining self-blame but removing other-blame in the PTSD-blame item; providing specific descriptions of depersonalization and derealization in the dissociation items; and removing risk-protection and functioning items for children.
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Affiliation(s)
- Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Shanelle Sotilleo
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rosalind Rogers
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Renee Doe
- International Psychology Ph.D. Program, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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17
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Lang JM, Connell CM, Macary S. Validating the Child Trauma Screen Among a Cross-Sectional Sample of Youth and Caregivers in Pediatric Primary Care. Clin Pediatr (Phila) 2021; 60:252-258. [PMID: 33853370 DOI: 10.1177/00099228211005302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.
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Affiliation(s)
- Jason M Lang
- Child Health and Development Institute, Farmington, CT, USA.,Yale University, New Haven, CT, USA.,UCONN Health, Farmington, CT, USA
| | | | - Susan Macary
- Child Health and Development Institute, Farmington, CT, USA
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18
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Pechorro P, DeLisi M, Abrunhosa Gonçalves R, Pedro Oliveira J. The Role of Low Self-Control as a Mediator between Trauma and Antisociality/Criminality in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020567. [PMID: 33445427 PMCID: PMC7826820 DOI: 10.3390/ijerph18020567] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 01/13/2023]
Abstract
Trauma exposure and low self-control are robustly associated with youth antisocial/criminal problems, but the interrelation of these constructs is unclear when taking into account both traumatic events and reactions. The objective of the present study is to examine self-control mediation effects related to trauma and juvenile delinquency, conduct disorder, crime seriousness, and aggression outcomes. The sample consisted of N = 388 male youth from Portugal (age, M = 16.01 years, SD = 1.03, age range = 13–18 years). Path analysis procedures revealed that self-control partially mediates the relation between trauma events and the examined outcomes and fully mediates the relation between trauma reactions and the examined outcomes. Research on youth trauma should examine both trauma events and trauma reactions because they have differential effects on low self-control and antisocial/criminal outcomes.
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Affiliation(s)
- Pedro Pechorro
- School of Psychology, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal;
- Correspondence:
| | - Matt DeLisi
- Department of Sociology and Criminal Justice, Iowa State University, 203A East Hall, Ames, IA 50011-1070, USA;
| | | | - João Pedro Oliveira
- School of Psychology and Life Sciences, Lusófona University of Humanities and Technologies, Campo Grande, 1749-024 Lisbon, Portugal;
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19
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Connell CM, Lang JM, Zorba B, Stevens K. Enhancing Capacity for Trauma-informed Care in Child Welfare: Impact of a Statewide Systems Change Initiative. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:467-480. [PMID: 31498465 PMCID: PMC7894977 DOI: 10.1002/ajcp.12375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Youth involved in the child welfare system (CWS) are disproportionally impacted by the negative effects of exposure to trauma. While efforts to develop trauma-informed CWSs are accelerating, little research is available about the effects of these efforts on system capacity to respond to the needs of youth exposed to trauma. No studies evaluate longer-term effects of these efforts. In 2011, Connecticut implemented CONCEPT, a multi-year initiative to enhance capacity of the state's CWS to provide trauma-informed care. CONCEPT used a multi-component approach including workforce development, deployment of trauma screening procedures, policy change, improved access to evidence-based trauma-focused treatments, and focused evaluation of program effects. Changes in system capacity to deliver trauma-informed care were assessed using statewide stratified random samples of child welfare staff at three time points (Year 1: N = 223, Year 3: N = 231, Year 5: N = 188). Significant improvements across nearly all child welfare domains were observed during the first 3 years of implementation, demonstrating system-wide improvements in capacity to provide trauma-informed care. These gains were maintained through the final year of implementation, with continued improvements in ratings of collaboration between child welfare and behavioral health settings on trauma-related issues observed. Responses documented familiarity with and involvement in many of the CONCEPT activities and initiatives. Staff reported greater familiarity with efforts to increase access to specific evidence-based services (e.g., TF-CBT) or to enhance trauma-related policy and practice guidelines, but less familiarity with efforts to implement new practices (e.g., trauma screening) in various sectors. Staff also reflected on the contribution of these components to enhance system capacity for trauma-informed care.
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Affiliation(s)
- Christian M. Connell
- Human Development and Family Studies and Child Maltreatment Solutions Network, Pennsylvania State University, University Park, PA, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jason M. Lang
- Child Health and Development Institute, Farmington, CT, USA
- Department of Psychiatry, UCONN Health, Farmington, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Bethany Zorba
- Connecticut Department of Children and Families, Hartford, CT, USA
| | - Kristina Stevens
- Connecticut Department of Children and Families, Hartford, CT, USA
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